Quality

Get with the Guidelines

Get with the Guidelines
Improving on the exceptional quality of care is important to the physicians and staff at the Marcus Stroke and Neuroscience Center. Sharing our performance data on a regular basis is our way of demonstrating this commitment.

The information contained on this site provides data on key performance measures. We also highlight some of the many quality initiatives the health system is undertaking to further enhance and improve quality for our patients.

Stroke Quality Measures

ComprehensiveStroke Center Measures

CSTK-1: NIHSS Score Performed for Ischemic Stroke Patients

Ischemic stroke patients for whom an initial NIHSS score is performed prior to any acute recanalization therapy (i.e., IV thrombolytic (t-PA) therapy, or IA thrombolytic (t-PA) therapy, or mechanical endovascular reperfusion therapy) in patients undergoing recanalization therapy and documented in the medical record, OR documented within 12 hours of arrival at the hospital emergency department for patients who do not undergo recanalization therapy.

Rationale: A neurological examination of all patients presenting to the hospital emergency department with warning signs and symptoms of stroke should be a top priority and performed in a timely fashion. Use of a standardized stroke scale or scoring tool ensures that the major components of the neurological examination are evaluated. Clinical practice guidelines from the American Heart Association/American Stroke Association recommend The National Institutes of Health Stroke Scale (NIHSS) as the preferred scoring tool for this purpose. Scores obtained aid in the initial diagnosis of the patient, facilitate communication among healthcare professionals, and identify patient eligibility for various interventions and the potential for complications.

2016 92.2%
2015 91%

 

CSTK-5: Hemorrhagic Transformation Overall Rate

Ischemic stroke patients who develop a symptomatic intracranial hemorrhage (i.e., clinical deterioration ≥ 4 point increase on NIHSS and brain image finding of parenchymal hematoma, or subarachnoid hemorrhage, or intraventricular hemorrhage) within (≤) 36 hours after the onset of treatment with intra-venous (IV) or intra-arterial (IA) thrombolytic (t-PA) therapy, or mechanical endovascular reperfusion procedure (i.e., mechanical endovascular thrombectomy with a clot retrieval device).

Rationale: Intravenous (IV) thrombolytic (t-PA) therapy for acute ischemic stroke was approved by the US Food and Drug Administration in 1996, following findings from the National Institute of Neurological Disorders and Stroke (NINDS) trial which demonstrated favorable outcomes in 31% to 50% of patients treated with recombinant tissue plasminogen activator (r-tPA), as compared to 20% to 38% of patients treated with placebo. Intra-arterial (IA) thrombolytic therapy (t-PA) has since been used to improve recanalization and clinical outcomes for select patients nonresponsive to IV therapy. Intracranial hemorrhage is the major risk of thrombolytic therapy with similar rates reported for both IV and IA routes. The NINDS trial found that 6.4% of patients treated with IV t-PA experienced symptomatic bleeding. Findings from the Prolyse in Acute Cerebral Thromboembolism (PROACT II) study found the intracranial hemorrhage with neurological deterioration within 24 hours occurred in 10% of patients treated with IA recombinant prourokinase. In addition to these agents, other available thrombolytic drugs include: streptokinase, p-anisoylated lys-plasminogen-streptokinase activator, and urokinase. Endovascular reperfusion therapy in acute ischemic stroke comprises a number of pharmacological and mechanical procedures. Mechanical endovascular thrombectomy is a treatment option for patients with large vessel occlusions in whom
pharmacological thrombolysis is contraindicated or might be ineffective. A number of mechanical endovascular thrombectomy devices, also known as clot retrieval devices, are currently undergoing clinical evaluation. Mechanical endovascular thrombectomy devices are intended to improve tissue rescue and diminish reperfusion hemorrhage while broadening the population eligible for therapy. These devices may be used alone or in conjunction with chemical thrombolysis (i.e., IV or IA t-PA).

2016 2.6%
2015 1.7%

 

CSTK-5a: Hemorrhagic Transformation for Patients Treated with IV tPA Only

Ischemic stroke patients who develop a symptomatic intracranial hemorrhage (i.e., clinical deterioration ≥ 4 point increase on NIHSS and brain image finding of parenchymal hematoma, or subarachnoid hemorrhage, or intraventricular hemorrhage) within (≤) 36 hours after the onset of treatment with intra-venous (IV) thrombolytic (t-PA) therapy only.

Rationale: Intravenous (IV) thrombolytic (t-PA) therapy for acute ischemic stroke was approved by the US Food and Drug Administration in 1996, following findings from the National Institute of Neurological Disorders and Stroke (NINDS) trial which demonstrated favorable outcomes in 31% to 50% of patients treated with recombinant tissue plasminogen activator (r-tPA), as compared to 20% to 38% of patients treated with placebo. Intra-arterial (IA) thrombolytic therapy (t-PA) has since been used to improve recanalization and clinical outcomes for select patients nonresponsive to IV therapy. Intracranial hemorrhage is the major risk of thrombolytic therapy with similar rates reported for both IV and IA routes. The NINDS trial found that 6.4% of patients treated with IV t-PA experienced symptomatic bleeding. Findings from the Prolyse in Acute Cerebral Thromboembolism (PROACT II) study found the intracranial hemorrhage with neurological deterioration within 24 hours occurred in 10% of patients treated with IA recombinant prourokinase. In addition to these agents, other available thrombolytic drugs include: streptokinase, p-anisoylated lys-plasminogen-streptokinase activator, and urokinase. Endovascular reperfusion therapy in acute ischemic stroke comprises a number of pharmacological and mechanical procedures. Mechanical endovascular thrombectomy is a treatment option for patients with large vessel occlusions in whom
pharmacological thrombolysis is contraindicated or might be ineffective. A number of mechanical endovascular thrombectomy devices, also known as clot retrieval devices, are currently undergoing clinical evaluation. Mechanical endovascular thrombectomy devices are intended to improve tissue rescue and diminish reperfusion hemorrhage while broadening the population eligible for therapy. These devices may be used alone or in conjunction with chemical thrombolysis (i.e., IV or IA t-PA).

2016 4.1%
2015 1.9%

 

CSTK-5b: Hemorrhagic Transformation for Patients Treated with IA tPA or MER Therapy

Ischemic stroke patients who develop a symptomatic intracranial hemorrhage (i.e., clinical deterioration ≥ 4 point increase on NIHSS and brain image finding of parenchymal hematoma, or subarachnoid hemorrhage, or intraventricular hemorrhage) within (≤) 36 hours after the onset of treatment with IA thrombolytic (t-PA) therapy or mechanical endovascular reperfusion therapy (i.e., mechanical endovascular thrombectomy with a clot retrieval device).

Rationale: Intravenous (IV) thrombolytic (t-PA) therapy for acute ischemic stroke was approved by the US Food and Drug Administration in 1996, following findings from the National Institute of Neurological Disorders and Stroke (NINDS) trial which demonstrated favorable outcomes in 31% to 50% of patients treated with recombinant tissue plasminogen activator (r-tPA), as compared to 20% to 38% of patients treated with placebo. Intra-arterial (IA) thrombolytic therapy (t-PA) has since been used to improve recanalization and clinical outcomes for select patients nonresponsive to IV therapy. Intracranial hemorrhage is the major risk of thrombolytic therapy with similar rates reported for both IV and IA routes. The NINDS trial found that 6.4% of patients treated with IV t-PA experienced symptomatic bleeding. Findings from the Prolyse in Acute Cerebral Thromboembolism (PROACT II) study found the intracranial hemorrhage with neurological deterioration within 24 hours occurred in 10% of patients treated with IA recombinant prourokinase. In addition to these agents, other available thrombolytic drugs include: streptokinase, p-anisoylated lys-plasminogen-streptokinase activator, and urokinase. Endovascular reperfusion therapy in acute ischemic stroke comprises a number of pharmacological and mechanical procedures. Mechanical endovascular thrombectomy is a treatment option for patients with large vessel occlusions in whom
pharmacological thrombolysis is contraindicated or might be ineffective. A number of mechanical endovascular thrombectomy devices, also known as clot retrieval devices, are currently undergoing clinical evaluation. Mechanical endovascular thrombectomy devices are intended to improve tissue rescue and diminish reperfusion hemorrhage while broadening the population eligible for therapy. These devices may be used alone or in conjunction with chemical thrombolysis (i.e., IV or IA t-PA).

2016 2.3%
2015 1.6%

 

CSTK-6: Nimodipine Treatment Administered

Subarachnoid hemorrhage (SAH) patients for whom nimodipine treatment was administered within 24 hours of arrival at this hospital

Rationale: Cerebral vasopasm is a serious complication following SAH, occurring in 30% to 70% of patients and accounting for nearly 50% of the deaths in patients surviving to treatment. Constriction of the arterial lumen results in diminished cerebral perfusion distal to the affected artery, which produces a delayed neurological deficit that may progress to cerebral infarction without early management of the ruptured aneurysm. The arterial narrowing that occurs in cerebral vasospasm is typically a transient or temporary event, lasting from a few days up to 3 weeks. Oral nimodipine is a proven and valuable treatment to prevent or limit the severity of cerebral vasospasm.

2016 94.6%
2015 87.5%

 

CSTK-8: Thrombolysis in Cerebral Infarction (TICI Post-Treatment Reperfusion Grade)
Ischemic stroke patients with a post-treatment reperfusion grade of TICI 2B or higher in the vascular territory beyond the target arterial occlusion at the end of treatment with intra-arterial (IA) thrombolytic (t-PA) therapy and/or mechanical endovascular reperfusion therapy

Rationale: The Thrombolysis in Cerebral Infarction (TICI) Reperfusion Grade is used to measure cerebral reperfusion. Four results are possible with this scoring system: 0 (no perfusion); 1 (perfusion past the initial occlusion, but no distal branch filling); 2 (perfusion with incomplete or slow distal branch filling); and , 3 (full perfusion with filling of all distal branches). Reperfusion past the target arterial occlusion and into the distal arterial bed and terminal branches, in conjunction with recanalization of the target arterial occlusion, demonstrates flow restoration or revascularization.
The Interventional Management of Stroke (IMS) I trial suggested that the combined use of reduced-dose intravenous (IV) thrombolytic (t-PA) therapy , followed by microcatheter delivered intra-arterial (IA) thrombolytic (t-PA) therapy, was safe and effective in selected ischemic stroke patients, as compared to patients treated with full dose IV t-PA in the National Institute of Neurologic disease and Stroke (NINDS) rt-PA trial. In IMS I, a final TICI 2/3 reperfusion was achieved in 62% of ischemic stroke patients treated.

2016 98.2%
2015 99%

 

Primary Stroke Center Measures

STK-1: VTE Prophylaxis
Ischemic and hemorrhagic stroke patients must receive VTE prophylaxis the day of/ day after admission
Rationale: stroke patients are at an increased risk of developing a DVT as opposed to other patients. A DVT (Deep Vein Thrombosis) is a blood clot.

National Performance Goal: 90%
2016 95.7%
2015 95.3%
2014 92%
2013 92%

 

STK-2: Antithrombotics Prescribed at Discharge
Discharged on Antithrombotic (a drug that reduces the formation of blood clots)
Rationale: data suggests patients that take daily antithrombotic after a stroke reduces morbidity and mortality.

National Performance Goal: 90%
2016 99.2%
2015 99.1%
2014 98%
2013 99%
STK-3: Anticoagulation for Patients Diagnosed with A-fib or A-flutter
Patient must be discharged on anticoagulant if presents with atrial fibrillation atrial flutter
Rationale: these are risk factors for stroke. Prescribing an anticoagulant at discharge helps prevent recurrence of stroke. If patient is ineligible for anti-coagulation therapy, a reason must be documented.

National Performance Goal: 90%
2016 97.9%
2015 99.1%
2014 96%
2013 99%
STK-4: Initiation of IV tPA within 3 hours of Last Seen Well for eligible patients
tPA must be given within the applicable timeframe (if indicated)
Rationale: t-PA administration in eligible patients is most effective if used within 3 hours of symptom onset. t-PA is a medication that helps break up the clot to restore blood flow to the brain. It is the only FDA approved medication available to treat an Acute Ischemic Stroke.

National Performance Goal: 90%
2016 100%
2015 98%
2014 94%
2013 94%
STK-5: Antithrombotic Therapy started by end of hospital day #2
Antithrombotics must be given by the end of Hospital day 2 or documented contraindication provided.
Rationale: studies show that administering antithrombotics within 2 days of stroke reduces morbidity and mortality.

National Performance Goal: 90%
2016 98.2%
2015 97.1%
2014 97%
2013 97%
STK-6: Patients should have an LDL level drawn within 48 hours of admission. Patients with LDL >100 should be discharged home on Statin therapy.
LDL level must be drawn for all strokes within 48 hours of arrival
Rationale: Patients with LDL > 100 mg/dL should be prescribed a Statin at discharge to reduce the recurrence of stroke. High cholesterol is a risk factor for stroke.

National Performance Goal: 90%
2016 99.6%
2015 99.8%
2014 100%
2013 99%
STK-8: Patients or family members must be provided with Stroke Education.
Stroke Education
Rationale: Patients with strokes must be educated on risk factors, activation of EMS, the importance of follow-up after discharge, medications they have been prescribed, and warning symptoms/ signs of stroke. Early activation of EMS and proper treatment of stroke significantly increases life spans of patients with stroke. Appropriate education is imperative to the reduction of morbidity and mortality.

National Performance Goal: 90%
2016 93.3%
2015 95.8%
2014 92%
2013 97%
STK-10: Rehab must be considered for all patients
Patient must be assessed for Rehab Services
Rationale: two-thirds of people that suffer strokes every year survive, leaving approximately 40% with some form of functional impairment. These patients require some form of rehabilitation.

National Performance Goal: 90%
2016 100%
2015 98.9%
2014 100%
2013 100%

 

2017 Get With The Guidelines® Stroke – Gold Plus, Target Stroke Honor Roll Elite Plus

The American Heart Association and American Stroke Association recognize this hospital for achieving 85% or higher compliance with all Get With The Guidelines® – Stroke Achievement Measures for two or more consecutive years and achieving Time to Intravenous Thrombolytic Therapy ≤ 60 minutes in 75% or more of applicable acute ischemic stroke patients treated with IV tPA AND Time to Intravenous Thrombolytic Therapy within 45 minutes in 50% of applicable acute ischemic stroke patients treated with IV tPA to improve quality of patient care and outcomes.

Marcus Stroke Center firsts…

  • First 24/7/365 Stroke Team in Georgia – established in 1992
  • First to discover t-PA (along with 7 other US centers) as an effective treatment for acute stroke leading to FDA approval in 1996, now a standard of care in Georgia and around the US
  • First to create a statewide hospital network (Georgia Coverdell Stroke Registry) in 2001 to mentor hospitals throughout Georgia to adopt new standards of stroke care, now a network of 64 collaborating hospitals
  • First to establish a regional multi-hospital acute stroke referral network in 2010 to provide cutting edge neuroendovascular therapeutics to save brain, minimize injury and promote recovery, now with more than 70 referring hospitals
  • First angiogram suite placed in a NeuroICU in the world (2010)
  • First NeuroICU to cross train nurses to work in both ICU and angiogram suite to improve patient care and continuity
  • First to publish evidence in a major peer review journal on patient outcomes after neuroendovascular intervention for acute stroke showing that high volume comprehensive stroke centers have better patient outcomes than low volume comprehensive stroke centers
  • First to use centralized video monitoring of patients with stroke to enhance safety reducing chances for self-injury while recovering from stroke
  • First public safety-net hospital to be certified by The Joint Commission as a Primary Stroke Center in 2005, and the first to be certified as a Comprehensive Stroke Center in 2013
  • First to establish the NIH funded Georgia StrokeNet (2013) by partnering with regional hospitals to enhance and accelerate discovery of promising treatments for patients with stroke